Subdural haematoma: symptoms, causes, treatment and recovery

The NHS says symptoms can happen after a head injury and may start straight away or come on gradually over a few weeks. Cambridge University Hospitals says most chronic subdural haematomas are small and do not cause symptoms, but some slowly expand, compressing and irritating the brain.

Cambridge adds that confusion alone is rarely related to the haematoma. Symptoms such as arm or leg weakness, speech difficulties or headaches are a better indicator that it is causing a problem.

• A bad headache that does not get better after taking painkillers.

• Feeling and being sick.

• Confusion and memory problems, or changes in personality such as being unusually aggressive.

• Drowsiness.

• Slurred speech and problems with swallowing.

• Blurred or double vision.

• Loss of balance and falls.

• Weakness of one side of the body, an arm or a leg, or a facial droop.

• Seizures (fits) or loss of consciousness.

The NHS says to go to A&E if you or your child have had a head injury and have been knocked out but have now woken up, vomited since the injury, a headache that does not go away with painkillers, a change in behaviour, problems with memory, been drinking alcohol or taking drugs just before the injury, a blood clotting disorder or take medicine to thin your blood, or had brain surgery in the past.

The NHS says to call 999 if someone has hit their head and has been knocked out and not woken up, has difficulty staying awake or keeping their eyes open, a fit, a fall from more than 1 metre or 5 stairs, problems with vision or hearing, clear fluid from the ears or nose, numbness or weakness, or problems with walking, balance, understanding, speaking or writing. Do not drive to A&E.

The NHS says that if you have a small haematoma that is only causing mild symptoms, you may be monitored and given no treatment, or given medicines to reduce swelling in the brain. But most people with a haematoma will need surgery to remove it.

Cambridge University Hospitals says the choice for a chronic subdural haematoma is surgery or conservative management. If it is small or an incidental finding, it may be monitored with outpatient follow-up and repeat CT scans, and blood-thinning medicines may be reversed. If surgery is chosen, an operation usually happens within a few days.

The NHS says that if you have had a serious head injury you may need a brain scan, such as a CT or MRI scan, to check for a subdural haematoma. Cambridge says blood tests will also be needed, especially if you take blood-thinning medication, and that history and examination help decide whether the haematoma is causing your symptoms.

Cambridge says that once the diagnosis is made, your doctor will discuss the condition with the neurosurgical team, and you may be transferred to a neurosurgical centre by ambulance.

The NHS says it is usually caused by a head injury. Cambridge says we do not fully understand why chronic ones form: a common idea is that an injury has caused a bleed in the subdural space which the body has failed to reabsorb and has sealed off. Only two in three people can remember a head injury beforehand, so the injury can be minor, such as banging your head on a cupboard door.

Cambridge explains that the brain gets smaller with age, which stretches the blood vessels crossing the space and makes them more prone to tearing with minor injuries.

• Taking blood-thinning medicines such as warfarin, apixaban, edoxaban, aspirin or clopidogrel.

• Being older.

• Being unsteady on your feet with an increased likelihood of falling.

• Liver disease, which makes bleeding or bruising more likely.

• Blood disorders or clotting disorders.

• Drinking alcohol to excess.

The NHS says subdural haematomas can be very serious and even with the best care there is a high risk of death. People with serious subdural haematomas can be left with long-term or permanent problems, such as problems with walking, talking and thinking, and may have seizures. It may not be possible to make a full recovery.

The NHS says you will be supported by a range of healthcare professionals, including physiotherapists, occupational therapists and speech and language therapists. Cambridge says wound dressings come off after three days, and clips or stitches are removed seven to 10 days after surgery if healed, and to watch for signs of infection.

Subdural haematoma is a neurosurgical emergency or urgent problem, so it is almost always managed through NHS emergency, neurosurgical and rehabilitation services. A CT scan is done in the emergency department, then you may be transferred to a neurosurgical centre. Private care is mostly relevant for later rehabilitation, and any private team should coordinate with the NHS neurosurgical team and your GP.